Objective To explore the epidemiological characteristics,risk factors,and pathogen distribution of stroke associated pneumonia in middle-aged and elderly patients.Methods A total of 822 middle-aged and elderly stroke patients treated in Second People's Hospital of Lishui from January 2020 to September 2023 were retrospectively selected,and they were divided into incidence group(n=217)and non-incidence group(n=605)based on the occurrence of stroke associated pneumonia.Clinical data,pathogen culture and drug sensitivity test results of two groups of patients were collected.Results There were significant differences in age,length of stay,smoking history,diabetes mellitus,hypertension,disturbance of consciousness,dysphagia,National Institutes of Health stroke scale(NIHSS)score at admission,hypoproteinemia,and gastric tube indwelling or not between two groups(P<0.05).Logistic regression analysis showed that age>65 years,length of stay≥15 days,smoking history,diabetes mellitus,disturbance of consciousness,dysphagia,NIHSS score≥13 points at admission,and indwelling gastric tube were risk factors for stroke associated pneumonia(P<0.05).A total of 251 pathogenic bacterial strains were cultured in the sputum of 217 patients,including 168 Gram negative bacteria,72 Gram positive bacteria,and 11 fungi.The main pathogens were 68 strains of Klebsiella pneumoniae(27.1%),50 strains of Pseudomonas aeruginosa(19.9%),41 strains of Staphylococcus aureus(16.3%),and 25 strains of Acinetobacter baumannii(10.0%).Klebsiella pneumoniae had a higher resistance rate to ampicillin and gentamicin,while Pseudomonas aeruginosa,Staphylococcus aureus,and Acinetobacter baumannii had a higher resistance rate to ampicillin and amoxicillin.Conclusion The occurrence of stroke associated pneumonia in middle-aged and elderly patients is related to age,comorbidities,disturbance of consciousness,dysphagia,indwelling gastric tubes,etc.,and there are many types of infectious pathogens.In clinical practice,it is necessary to strengthen the identification of high-risk factors and select appropriate antibiotics for treatment based on drug sensitivity tests.

Objective To investigate the therapeutic effects of titanium artificial auditory ossicles in closed type mastoid radical tympanoplasty ,in comparison with ceramic artificial auditory ossicles .Methods A retrospec‐tive analysis was done on of 150 patients (155 ears) with the closed type of mastoid radical tympanoplasty using arti‐ficial auditory ossicles for hearing reconstruction (from January 2008 to December 2012) ,cund were ,and followed up for 12 months .Based on the two kinds of artificial auditory ossicle materials ,the group was divided into two :122 cases (127 ears) for the titanium auditory ossicle group and 28 cases (28 ears) for the ceramic auditory ossicle group .We compared the average air conduction hearing threshold and air bone gaps (ABG) at 0 .5 ,1 .0 ,2 .0 ,and 4 .0 kHz ,at preoperative 6 months and postoperative 6 ,12 months .Results For the Titanium artificial auditory os‐sicle group:117 ears (92 .13% ) had hearing threshold improvement >15 dB HL ,106 ears of the ABG change ≤20 dB ,which were statistically significant .The total success rate of hearing reconstruction was 83 .46% (106/127) . For the ceramic auditory ossicle group:5 ears (17 .86% ) had hearing threshold improvement >15 dB HL ,3 ears (10 .71% ) of the ABG change ≤20 dB ,which was no statistical significance between the two groups .Conclusion The hearing reconstruction effects of titanium artificial auditory ossicle in closed type mastoid radical tympanoplasty is excellent .It is suitable for application in closed-mastoidectomy tympanoplasty ideal artificial auditory ossicle .

AIM: To investigate the effects of protein C activator (PCA) from Agkistrondon acutus venom ( AAV) on the tension of thoracic aorta rings isolated from the rats with sepsis.METHODS:The model of sepsis was es-tablished by intraperitoneal injection of lipopolysaccharide ( LPS) .SD rats were randomly divided to 6 groups ( n=6 ):sham group, LPS group, PCA intervention group (LPS+PCA, PCA at doses of 0.1 mg/kg, 0.3 mg/kg and 0.6 mg/kg) and LPS+polymyxin B (at dose of 0.2 mg/kg) group.Using perfusion experiment in vitro, the tension of the aortic rings was measured by biological signal analytical system.RESULTS:The values of MABP, HR, LVDP and ±dp/dtmax were significantly lower in LPS group than those in sham group and LPS+PCA groups.Compared with sham group, the relaxa-tion response to acetylcholine ( ACh) and the contractile response of aorta rings induced by phenylephrine ( Phe) were sig-nificantly decreased in LPS group, which were increased significantly in PCA intervention group ( especially at dose of 0.6 mg/kg) compared with LPS group.The dose-response curve of aorta contraction with denuded endothelium induced by Phe shifted down significantly in LPS group compared with sham group, and no significant difference between LPS group and PCA intervention group was observed.Also no statistical difference was found in non-endothelium dependent relaxation of aortic rings induced by sodium nitroprusside among the groups.Pretreatment of N-nitro-L-arginine methl ester and methyl-ene blue increased the contraction amplitude of aortic rings induced by Phe.CONCLUSION:PCA from AAV effectively reverses the hypoergia of the vessels in rats with sepsis through protecting vascular endothelium, the mechanism of which may be mediated by inhibiting NO-GC-cGMP signal transduction pathway.

OBJECTIVE: To investigate the leukotriene D4 synthase gene A (LTD4S A)-444 C polymorphism in persistent allergic rhinitis (AR) of Chinese Han nationality and to evaluate its relevance to clinical responsiveness of leukotriene receptor antagonist. METHOD: There were 150 patients [87 males, 63 females, average age (38 +/- 14)] diagnosed with persistent AR in Allergy clinic in our hospital from March 2010 to March 2012; 146 healthy controls (78 males, 68 females, mean age (39 +/- 12)). We detected LT D4SA-444C polymorphism and allele frequencies with Polymerase Chain Reaction (PCR) and-Restriction Fragment Length polymorphism (RELP). The treatment group received monotherapy leukotriene receptor antagonist (montelukast) for 4 weeks. Urinary leukotriene D4 (LTD4) levels were detected by enzyme-linked immunosorbent assay (ELISA) before and after treatment, respectively. We evaluated anti-leukotriene treatment response according to the changement of symptoms, signs PTS and urinary LTD4. We tested correlation between LT D4S gene-444C allele frequency and the treatment response by multivariate analysis of variance. RESULT: (1) LTD4S gene-444 genotype AA/CC, AC/CC frequency is 70.7% (106/150) and 29.3% (44/150), allele A, C frequencies is 67.3% (101/150) and 32.7% (49/150) in AR group, and LTD4S gene-444 genotype AA/CC, AC/CC frequency is 76.7% (112/146) and 23.3% (34/ 146), allele A, C frequencies is 74.0% (108/146) and 26.0% (38/146) in healthy control group, there is not statistically significant difference between two groups. (2) Among 150 AR patients, compared to patients with AA/CC genotype, the genotype AC/CC patients are younger [average age (35 +/- 9), and (50 +/- 18) respectively, F = 5.891, P < 0.05], with earlier age of onset [(31 +/- 4), and (46 +/- 6) respectively, F = 6.985, P < 0.05], longer course of disease [(8.7 +/- 2.1), and (3.1 +/- 2.0) respectively, F = 11.43, P < 0.05], higher symptom scores (8.2 +/- 0.2; 4.8 +/- 0.3), higher signs score (7.3 +/- 3.3; 3.4 +/- 5.1), and the difference was statistically significant. (3) After 4 weeks of montelukast treatment in AR patients, treatment response of anti-leukotriene in genotype AC/ CC patients is better than those in AA/CC genotype patients (F = 11.01, P < 0.05), the differences of treatment response between two groups were correlated with LTD4 levels in vivo, clinical symptoms and signs of patients. CONCLUSION In a Chinese Han population the LTD4SA-444B polymorphism might be one of the factors in the clinical response to leukotriene receptor antagonists in persistent AR patients.
Adult ; Arachidonate 5-Lipoxygenase ; genetics ; Case-Control Studies ; Female ; Gene Frequency ; Humans ; Leukotriene Antagonists ; therapeutic use ; Male ; Middle Aged ; Polymorphism, Genetic ; Rhinitis, Allergic ; drug therapy ; genetics ; Young Adult

OBJECTIVE: To investigate the expression of major histocompatibility complex class I chain-related gene A (MICA) in laryngeal squamous cell carcinoma(LSCC), and its clinical significance. METHOD: Immunohistochemistry and RT-PCR were used to detect the expression of the MICA in LSCC and normal tissue samples. The relationship between the expression of MICA and the clinicopathologic features features were was analyzed. RESULT: Compared to the expression of MICA in normal tissues samples, the expression of MICA in LSCC tissue was significantly increased (P < 0.01). MICA expression level in carcinoma tissue was closely related to the tumor-differentiation degree and TNM staging. CONCLUSION Our study suggests that MICA may play an important role in the invasion and metastasis of LSCC, and could be a potential tumor maker for LSCC.
Aged ; Carcinoma ; genetics ; pathology ; Female ; Histocompatibility Antigens Class I ; genetics ; Humans ; Immunohistochemistry ; Laryngeal Neoplasms ; genetics ; pathology ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Staging ; Real-Time Polymerase Chain Reaction

OBJECTIVE: To evaluate the treatment responses of persistent allergic rhinitis with and without eosinophils (EOS) in nasal discharge to inhaled glucocorticosteroid (CS), and therefore to verify whether low eosinophil level in nasal discharge can predict poor response to treatment with CS. METHOD: Forty-two symptomatic allergic rhinitis patients, who had not received CS therapy in three months preceding the study, were examined before and 2 month, 4 months and 6 months after treatment with CS. At each visit, all patients underwent symptom scoring and physical sign scoring. The level of eosinophil cationic protein (ECP) in the nasal discharge supernatants was measured by radioimmunoassay. The patients were divided into 2 groups according to nasal discharge EOS percentages, an EOS group (EOS > or = 3%) and a non-EOS group (EOS < 3%). The response to CS therapy (as measured by symptom and physical sign scores) and the changes of nasal discharge measurements were compared between the 2 groups. RESULT: In the EOS group, the baseline EOS [0.086 (0.065; 0.176)] and ECP level [(326 +/- 145) microg/L] were significantly higher than EOS [0.016 (0.005; 0.022)] and ECP level [(154 +/- 58) microg/L] of the non-EOS group, t = 4.40, 3.32, respectively, all P < 0.01. After 2 months and 6 months of CS therapy, the nasal discharge EOS, ECP level were 0.038 (0.006; 0.070), 0.019 (0.010; 0.060), (175 +/- 122) microg/L, (175 +/- 153) microg/L, respectively in the EOS group,which were significantly different as compared to baseline values (F = 6.73, 7.38, respectively all P < 0.05). But in the non-EOS group, the nasal discharge EOS and ECP level were 0.014 (0.004; 0.032), 0.015 (0.010; 0.026), (118 +/- 60) microg/L, (112 +/- 60) microg/L, respectively at 2 and 6 months, which showed that the nasal discharge EOS level and the symptom and physical sign scores did not improve significantly (F = 0.82, P > 0.05), but the ECP level did improve (F = 3.78, P < 0.05). The average daily dose of CS was not different between the two groups at any visits. CONCLUSION In persistent allergic rhinitis with low EOS in nasal discharge, CS therapy for 6 months failed to improve symptoms and physical signs.
Administration, Inhalation ; Adult ; Eosinophil Cationic Protein ; Eosinophils ; pathology ; Female ; Glucocorticoids ; administration & dosage ; Humans ; Leukocyte Count ; Male ; Middle Aged ; Rhinitis, Allergic ; drug therapy ; metabolism ; pathology ; Treatment Outcome

OBJECTIVE: Investigate the effect of three-grade preventive health education and lifestyle intervention in the treatment of allergic rhinitis (AR). METHOD: Two hundred and ten selected cases needed for triple prevention were randomly divided into three groups, each group included 70 cases were undertaken for a three-year randomized controlled study. Group A, treated with Budesonide nasal spray. Group B, combined Budesonide nasal spray with Hydrochloric acid left Kabbah Sting nasal spray. Group C, taking health education management and lifestyle intervention on the basis of group B's therapy. A health lecture or health problems counseling and the dissemination of health education information were undertaken, quarterly. It was mainly for health knowledge awareness, and healthy behaviors formation rate guidance. Lifestyle intervention included a balanced diet, avoiding the allergens of living environment and aerobic exercise (daily 0.5-1.0 h). The score of the signs and symptoms in each group were obtained respectively at the beginning of study, 1 year after intervention and 3 years after intervention, as well as the comparison of patient compliance of follow-up. RESULT: The improved score of the signs and symptoms, endoscopy and radiological results were used to evaluate the treatment effect. There was no significant difference among the score of signs and symptoms in three groups. Comparing in group, before intervention,1 year after intervention and 3 years after intervention, the signs and symptoms of patients in three groups had improvement at different degree. The score of four symptoms (rhinobyon, rhinorrhoea, rhinocnesmus, sneezing) and signs were significant lower than before the intervention, there were a significant difference (P < 0.05). There were 8 patients in group A (11.43%), 6 patients in group 13 (8.57%) and 1 patient in group C (1.43%) lost to follow-up at 3 years after the intervention. The patient compliance of group C was significantly higher than groups A and B. CONCLUSION Triple prevention health education for AR can significantly improve the treatment compliance of AR patients for treatment, while ensuring clinical efficacy.
Adult ; Budesonide ; therapeutic use ; Health Education ; Humans ; Life Style ; Middle Aged ; Rhinitis, Allergic ; Rhinitis, Allergic, Perennial ; prevention & control ; therapy

ObjectiveTo investigate the feasibility of examining aortic pulse wave velocity (PWV),aortic distensibility (AD) and brachial artery flow-mediated dilation (FMD) by means of highresolution 3.0 T MRI.MethodsA total of 32 healthy volunteers underwent high-resolution MRI to assess aortic PWV,and AD in ascending aorta (AA),proximal descending aorta (DA),distal descending aorta (DDA) and FMD of the brachial artery with repeat examination performed in 1-2 hours.PWV was evaluated by 2D Phase Contrast (PC) velocity-encoded MRI with a 4.7-7.8 ms temporal resolution.Fiesta-cine MRI was used to assess AD and FMD with a 18.75-31.25 ms temporal resolution.The image quality of these two scans was scored and the agreement between them was tested with Kappa analysis.The reproducibility of the results between repeated measurements of PWV,AA-AD,DA-AD,DDA-AD and FMD was assessed with intra-class correlation coefficient (ICC) analysis.The method of Bland-Altman plot was used to assess the agreement between results of repeated studies.Results Each examination including PWV,AD and FMD were completed in about half an hour.The image quality between repeated scans showed good agreement ( Kappa value 0.776 ) with the score of ( 3.53 ± 0.62 ) and ( 3.41 ± 0.67 ) respectively.Reproducibility between repeated measurements was high for aortic PWV [ (4.33 ± 0.88 ) vs ( 4.36 ±0.88) m/s],AA-AD [(8.60±3.11) × 10-3 vs (8.59 ± 3.10) × l0-3/mm Hg(1 mm Hg =0.133 kPa) ],DA-AD[ (6.95 ±2.44) × 10-3 vs (6.95 ±2.42) × 10-3/mm Hg],DDA [(10.54 ±2.91) ×l0-3 vs (10.55 ±2.90) × 10-3/mm Hg] and FMD [(24.94 ± 12.55)％ vs (24.92 ±1 2.38 ) ％ ].ICC were 0.95,0.97,0.99,0.98 and 0.94,P ＜ 0.01.Excellent agreement between repeated measurements was found for aortic PWV [ confidence interval (CI) between - 0.55 and 0.50 ],AA-AD ( CI between - 0.11 and 0.12 ),DA-AD ( CI between - 0.08 and 0.08 ),DDA-AD ( CI between - 0.23 and 0.21 ) and FMD (CI between - 1.46 and 1.51 ).The maximum difference percentage in minimum average for aortic PWV,AA-AD,DA-AD,DDA-AD and FMD was 38.53％,9.65％,3.86％,5.68％,42.37％,respectively,all less than 50％.Conclusion Comprehensive assessment of aortic compliance and brachial endothelial function can be achieved using 3.0 T high-resolution MRI with excellent reproducibility and within a reasonable amount of time.

Objective To investigate the imaging features of focal nodular hyperplasia and hepatocellular carcinoma on DWI. Methods The data of patients with histopathologically confirmed FNHs and HCCs between August 2008 and November 2010 were collected. A total of 24 patients with 26 FNH lesions and 36 patients with 39 HCC lesions were included in our study. All patients underwent breath-hold DWI with b = 500 s/mm2 and dynamic contrasted-enhanced (DCE) MRI. The imaging findings of FNHs and HCCs were retrospectively analyzed and compared. The signal intensity (SI) of the lesions on DWI were classified as iso-, slightly high, high SI and the distribution of SI between FNHs and HCCs was compared with Fisher exact test. ADC value and lesion-to-liver ADC ratio of FNHs and HCCs were measured and compared by using independent sample t test. ROC was performed to assess the diagnostic value of ADC value and lesion-liver ADC ratio in the characterization FNHs versus HCCs. Results Of 26 FNHs,23 manifested as isointensity or slightly high SI on DWI, but most 25 out of 39 HCCs showed high SI. The distribution of SI between FNHs and HCCs had significant difference ( P = 0. 000). The mean ADC value and lesion-liver ADC ratio for FNHs [ (1.76 ± 0. 62 ) × 10-3 mm2/s and 1.06 ± 0. 18, respectively ] were significantly higher ( P = 0. 001, P = 0. 000, respectively ) than those for HCCs [ ( 1.26 ± 0. 46 ) × 10-3mm2/s and 0. 79 ±0. 12, respectively]. The area (Az) under the ROC for the ADC value and lesionliver ADC ratio for the differentiation of FNHs versus HCCs were 0. 79 ± 0. 05 and 0. 85 ± 0. 05,respectively, with no significant difference (P =0. 270). The specificity of the two measures was 69. 23% and 97.44%, respectively, with significant difference (P = 0. 001 ). Conclusion FNH shows isointensity or slightly high SI with relatively higher ADC value and lesion-liver ADC ratio than those of HCCs on DWI,which is characteristic for its diagnosis and differentiation.

OBJECTIVE: To study the effects of long term use of beclomethasone dipropionate (BDP) nasal spray on bone density with perennial allergic rhinitis (AR) in adults. METHOD: A 5-year randomized study was conducted on the effects of BDP nasal spray on serum calcium, phosphorus, alkaline phosphatase, and bone density determined before and after the treatment in 36 adult patients with perennial AR. 20-45 years of age, were randomly divided into 3 groups. That is group A (nasal spray 1 - <3 year), group B (nasal spray BDP 3 - <5 year) and group C (nasal spray BDP > or =5 year). The data were analyzed by paired t test. RESULT: The perennial AR were followed up for more than > or =1 year, > or =3 year and > or =5 year to observe the influences of nasal spray BDP. There were no significant difference between the data examined before and after the treatment (P > 0.05). Bone development is not influenced by nasal spray BDP < or =400 microg/d within 5 years. CONCLUSION Long term use of BDP nasal spray in adult patients does not lead to osteoporosis if the lowest effective steroid dose is given.
Adult ; Alkaline Phosphatase ; blood ; Beclomethasone ; administration & dosage ; adverse effects ; therapeutic use ; Bone Density ; drug effects ; Calcium ; blood ; Female ; Humans ; Male ; Middle Aged ; Phosphorus ; blood ; Rhinitis, Allergic, Perennial ; drug therapy ; metabolism ; physiopathology ; Young Adult